Provider Demographics
NPI:1669761920
Name:HOUSTON, MI'QUAEL ALIZIA (MD)
Entity type:Individual
Prefix:DR
First Name:MI'QUAEL
Middle Name:ALIZIA
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MI'QUAEL
Other - Middle Name:ALIZIA
Other - Last Name:COTTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N STATE ST
Mailing Address - Street 2:IPT, ROOM C4E100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1029
Mailing Address - Country:US
Mailing Address - Phone:323-409-4597
Mailing Address - Fax:323-441-8085
Practice Address - Street 1:4650 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6306
Practice Address - Country:US
Practice Address - Phone:310-823-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107684207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology